Impact on Morbidity, Mortality, and Length of Stay of Hospital-Acquired Infections by Resistant Microorganisms
Impact on Morbidity, Mortality, and Length of Stay of Hospital-Acquired Infections by Resistant Microorganisms
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DOI：
10.1093/cid/cix411
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发表时间：
2017-08-15
影响因子：
11.8
通讯作者：
Moliner-Lahoz, Javier
中科院分区：
文献类型：
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作者：
Barrasa-Villar, J. Ignacio;Aibar-Remon, Carlos;Moliner-Lahoz, Javier
背景资料。耐多药生物体(MDRO)感染是一种全球性威胁，在医院尤为常见。本研究旨在评估耐多药耐药菌引起的医院感染对发病率、死亡率和住院时间的影响。这是一项回溯性队列研究。选择了一组18岁的成人样本，这些成人患有由耐多药微生物(病例)或敏感微生物(对照)引起的呼吸道、尿路、血液或手术部位感染。测量包括所有原因的住院死亡率(总死亡率和感染后30天)、住院时间(LOS)和5项发病率指标：重症监护或手术入院、感染后诊断测试次数、出院30天内再次住院或去急诊科就诊。样本由324例患者和676例对照患者组成。在MDRO感染的患者中，所有原因的住院死亡风险(危险比[HR]，1.7；95%可信区间[CI]，1.25-2.32)和感染后30天的死亡率(HR，1.77；95%CI，1.29-2.44)更高。病例组再入院的概率也较高(优势比[OR]为2.17；95%可信区间为1.36~3.46)。急诊科就诊人数仅在耐甲氧西林金黄色葡萄球菌(OR，2.80；95%CI，1.65-4.74)和耐大肠杆菌感染(OR，2.28；95%CI，1.32-3.96)中显著增加。MDRO感染与任何其他结果无关。与敏感菌株引起的医院感染相比，多药耐药菌引起的医院感染增加了死亡率、再次入院，在某些情况下，还增加了急诊科的就诊次数。它们似乎不会影响LOS，也不会影响住院、重症监护、手术或诊断测试的需要。
Background. Infections by multidrug-resistant organisms (MDROs) are a global threat and are particularly common in hospitals. This study was performed to assess the impact of hospital-acquired infections caused by MDROs on morbidity, mortality, and length of hospital stay.Methods. This was a retrospective cohort study. A sample of adults aged >= 18 years with a respiratory, urinary, bloodstream, or surgical site infection caused by a multidrug-resistant (cases) or -sensitive (controls) microorganism was selected. Measurements included hospital mortality from all causes (total and 30 days after infection), length of stay (LOS), and 5 indicators of morbidity: intensive care or surgery admissions, number of diagnostic tests after infection, and hospital readmissions or visits to the emergency department within 30 days of discharge.Results. The sample was composed of 324 cases and 676 control patients. Risk of hospital mortality from all causes (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.25-2.32) and 30 day-mortality after infection (HR, 1.77; 95% CI, 1.29-2.44) were higher in patients with an MDRO infection. Probability of readmission was also higher (odds ratio [OR], 2.17; 95% CI, 1.36-3.46) in the case group. Emergency department visits were only significantly higher in methicillin-resistant Staphylococcus aureus (OR, 2.80; 95% CI, 1.65-4.74) and in Escherichia coli-resistant infections (OR, 2.28; 95% CI, 1.32-3.96). Infections by MDRO were not associated with any other outcome.Conclusions. Hospital infections caused by MDROs increase mortality, readmissions, and in some cases, visits to the emergency department compared with those produced by susceptible strains. They do not appear to influence LOS nor the need for hospital admission, intensive care, surgery, or diagnostic tests.